Predictors of autoimmune hemolytic anemia in beta-thalassemia patients with underlying red blood cells autoantibodies

Abstract In beta-thalassemiapatients, erythrocyte autoantibodies can remain silent or lead to Autoimmune Hemolytic Anemia(AIHA).The aim of this study was to identify predictors of AIHA in beta-thalassemiapatients with positive Direct Antiglobulin Test(DAT), in Tunisia. This longitudinal prognosis study was carried out on beta-thalassemiapatients with a positive confirmed DAT. Predictors of AIHA were identified the Kaplan-Meier method. A Cox model analysis was used to identify independent predictors. Among 385 beta thalassemiapatients, 87 developed positive DAT (22.6%). Autoimmune hemolytic anemiawas occurred in 25 patients. Multivariate analysis showed that AIHA was independently associated with beta- thalassemia intermediaand similar family historyof AIHA. Splenectomyin patients with positive DAT was independently associated with an increased risk of AIHA (HR = 6.175, CI: 2.049–18.612, p  In summary, splenectomyafter autoimmunization, prior alloimmunization, DAT specificity (IgG with complement), thalassemia intermedia, AB blood group and family historyof AIHA were strongly associated with AIHA. Leukoreduced blood transfusion had a proven preventive role.